Learn more about migraine attacks, including possible causes, treatments and how to get help.

Your head is throbbing, your stomach is queasy and bright lights or loud noises make you feel even worse. If you’re one of the estimated 30 million Americans who get migraine headaches, you’re no doubt familiar with these classic symptoms of a migraine attack.

Although “migraine” is often used to describe any splitting headache, a true migraine headache has distinctive characteristics. For one thing, the pain is typically moderate to severe, with a throbbing or pulsating feeling. A migraine attack generally lasts between four and 72 hours, but, in some cases, it can last an entire week.

Other symptoms of migraine headaches include nausea or vomiting or sensitivity to light, sound or odor. In about 60% of cases, the pain centers on one side of the head and face.

An aura, a reversible neurological symptom, may also occur shortly before or at the onset of pain and last 5-60 minutes. The most common type of aura involves visual changes – seeing spots, specks or wavy or shimmering lines, usually in just one side of your visual field.

Less common are sensory auras, which involve numbness or tingling in the hands or face, or language auras, in which people have trouble speaking.

But auras occur less commonly than you may think.

“Only about 20% of migraine patients will experience one,” says neurologist Brian Grosberg, M.D., director of the Inpatient Headache Program at Montefiore Headache Center in New York City.

When headache pain is accompanied by speech difficulties, he says, it’s important to rule out other serious conditions such as stroke and seizures, which can cause similar speech and language problems.

Migraines occur most often in adults between the ages of 20 and 50, and are three times more common in women than men. It’s not understood why, but experts say hormones play a role.

Many women have migraine attacks around the time of their periods or find their attacks are more severe then.

“Research shows that normal hormonal fluctuations associated with menstruation trigger migraines for many women,” says Ana Recober-Montilla, M.D., assistant professor of neurology in the division of headache medicine at University of Iowa Health Care.

Many other things can elicit migraine attacks, Grosberg says. These include certain foods (such as red wine or chocolate), dehydration, changes in weather or altitude, hormonal fluctuations, stress, lack of sleep, and even bright sunlight or strong odors, such as perfume.

“Not every person with migraines has triggers,” he says, “but some people have multiple triggers.”

But a migraine “trigger” is not the same thing as a migraine “cause,” says Frederick G. Freitag, D.O., medical director of the Comprehensive Headache Center at Baylor University Medical Center in Dallas.

“Migraine is almost certainly inherited and definitely familial. Once you have the tendency towards migraine, then a variety of triggers can result in migraine attacks,” he says.

There’s no doubt that migraine headaches are debilitating and interfere with daily activities. But experts say migraines often go undiagnosed or misdiagnosed for months or years.

In fact, less than half of patients whose symptoms met the criteria for migraine had been diagnosed with the condition, according to a 2000 survey conducted by the National Headache Foundation.

“Around 90% of patients who believed their headaches were sinus headaches had normal sinuses. Their symptoms were due to migraine,” she says.

To manage your migraine, a critical first step is to keep a detailed headache diary of the days and times you experience migraine pain, how long the headaches last, as well as possible triggers, such as foods, lack of sleep or where you are in your menstrual cycle.

Without such a diary, “the patient may not be able to give an accurate picture of their migraines, and the doctor may not get a true sense of the level of severity and how badly they affect a person’s quality of life,” Grosberg says.

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